Tibial OCL

Osteochondral Defects

Description of patient (type of occupation, indication of age, intensity of sport):

35 year old man sustained an injury to the ankle 1 year ago. He has ongoing pain, swelling.

History and previous treatment:

Xrays- large cystic OCL in the anterior tibial plafond.

Current complaints:

Pain, mostly activity related.

Physical examination:

Normal range of motion, with an ankle effusion.


[Picture 1]
OCL of the anterior tibial plafond

Additional investigation (CT/MRI)
[Picture 2]


Case summary:

35 year old man with ongoing pain and an OCL of the distal tibia(Large and cystic).

Question(s) to this case:

Would you bone graft this through the ankle or through the anterior tibial cortex, or would you just debride and micro fracture? Scope for sure, but don't know the best way to graft this?


For preoperative planning I always make a CT. I would go for arthroscopy to identify the entrance of the lesions and then for retrograde drilling (+ curetting the wall and microfracture the walls) probably from anteromedial and fill it with cancellous bone: can be partially autologous.